Cholesterol Embolism Treatment & Management

  • Author: Lisa Kirkland, MD, FACP, CNSP, MSHA; Chief Editor: Vincent Lopez Rowe, MD   more...
 
Updated: Aug 31, 2011
 

Medical Care

Medical management is supportive.

  • Hemodynamic monitoring, including pulmonary artery catheterization, may be helpful for fluid and vasopressor adjustments.
  • If ARDS occurs, mechanical ventilation may be required for a prolonged period.
  • Dialysis should be started when indicated because patients can recover limited renal function.
  • Aggressive nutritional and metabolic support is essential because these patients often lose considerable lean body mass to ongoing catabolism.
  • Further invasive vascular procedures and anticoagulant or thrombolytic therapies should be avoided. If they are unavoidable, downstream protection devices to trap atheromatous debris after stenting or angioplasty are suggested.
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Surgical Care

  • Surgical therapy, such as aortic aneurysm resection, may be necessary to remove the source of atheroembolic material. Stent-grafting may be less invasive method to reduce risk of embolization.
  • Damaged tissue should be protected and allowed to demarcate for several months. Surprisingly, a majority of the damage may recover. Necrotic tissue should be debrided, and establishing vascular access for dialysis also may be necessary.
  • In severe cases, lumbar sympathetic block (rarely, surgical sympathectomy) has been used to avoid impending lower extremity tissue loss resulting from intense vasoconstriction.
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Consultations

  • Nephrologist
  • Critical care specialist
  • Metabolic and nutritional support specialists
  • General and/or vascular surgeons
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Contributor Information and Disclosures
Author

Lisa Kirkland, MD, FACP, CNSP, MSHA  Assistant Professor, Department of Internal Medicine, Division of Hospital Medicine, Mayo Clinic; ANW Intensivists, Abbott Northwestern Hospital

Lisa Kirkland, MD, FACP, CNSP, MSHA is a member of the following medical societies: American College of Physicians, Society of Critical Care Medicine, and Society of Hospital Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard M Stillman†, MD, FACS  Honorary Medical Staff, Northwest Medical Center; Former Chief of Staff and Medical Director, Wound Healing Center, Department of Surgery, Northwest Medical Center

Richard M Stillman†, MD, FACS is a member of the following medical societies: American College of Angiology, American College of Surgeons, Association for Academic Surgery, and Society of University Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Travis J Phifer, MD  Chief, Division of Vascular Surgery, Professor, Department of Surgery and Radiology, Louisiana State University Health Sciences Center in Shreveport

Travis J Phifer, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Society for Academic Emergency Medicine, Society for Vascular Surgery, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Paolo Zamboni, MD  Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy

Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

Vincent Lopez Rowe, MD  Associate Professor of Surgery, Department of Surgery, Division of Vascular Surgery, University of Southern California Medical Center

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, Pacific Coast Surgical Association, Peripheral Vascular Surgery Society, Society for Clinical Vascular Surgery, Society for Vascular Surgery, and Western Vascular Surgical Society

Disclosure: Nothing to disclose.

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